I recently had the pleasure of joining the Southern California Psychiatric Society as they welcomed Ned Hallowell, MD and Michael Enenbach, MD to speak about adult and childhood ADHD. I would recommend Dr. Hallowell’s book Driven to Distraction and greatly admire how he has fought to educate the public about ADHD. Dr. Enenbach was my attending psychiatrist when I was in residency and learning about child psychiatry at UCLA’s Neuropsychiatric Institute.
Some may be wondering now, what is ADHD? ADHD is a collection of symptoms that create distractability and impulsivity. Here is the list of criteria of symptoms for a diagnosis of ADHD (only some of these are needed for the diagnosis):
- Inattentive presentation
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Has difficulty with organization
- Avoids or dislikes tasks requiring a lot of thinking
- Loses things
- Is easily distracted
- Is forgetful in daily activities
- Hyperactive-impulsive presentation
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively in children; extreme restlessness in adults
- Difficulty engaging in activities quietly
- Acts as if driven by a motor; adults will often feel inside like they were driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty waiting or taking turns
- Interrupts or intrudes upon others
- Combined inattentive & hyperactive-impulsive presentation
- Has symptoms from both of the above presentations
Dr. Hallowell began explaining ADHD as a constellation of symptoms that affect the way in which we view people. He described children for most of history with ADHD who were viewed as “bad” and at certain times in history viewed as having the “devil” in them. As a result, these children were often abused by those who should have been there to help and protect them. They were thought of as being children who were choosing not to listen to the rules instead of being understood as children who couldn’t listen to the rules.Eventually, this disease was thought to be a result of dysfunction of the brain and was called “minimal brain dysfunction”. While that label certainly is not used today, it was actually great progress as it was then thought of as an ailment that afflicted some people, rather than a conscious choice of disobedience.
With that progress, there were great strides made towards diagnosing men. Unfortunately, many women with ADHD were diagnosed with depression or anxiety. It was thought of for many years as a predominately male disease. Many psychiatrists today still view it that way. What we now know is that it is crucial to take a thorough history and pick up on certain subtleties that would lead to this diagnosis. Of course one would be depressed and anxious if they had untreated ADHD.
What I have seen in my practice is exaclty what Dr. Hallowell reports, “I don’t think there is any diagnosis in medicine that can change your life the way that this could.” ADHD is disordered disinhibition. It is having an innate curiosity, but not being able to contain it. It is having “a Ferrari engine with bicycle brakes” according to Dr. Hallowell. LA and NY are filled with creative entrepreneurs who have ADHD, and sadly many of them have been untreated. This leads to the question, what could they have accomplished if they had been treated? Many of those treated in adulthood are very intelligent and have accomplished a lot in their lives, and yet they still have a pattern of unexplained underachievement. They often weren’t at their best because they were not able to concentrate and organize their lives as they should have. They have so many wonderful new ideas, but have such trouble implementing them.
ADHD also affects one’s personal life. Many with it go through serial relationships and marriages, often unable to make a full commitment to the one person they are with and unable to stay focused when having intimate moments. This is often the most distressing to patients. Their ability to manage time is fundamentally different, there is “now” and “not now”, according to Dr. Hallowell. They lead lives of chronic procrastination. They save everything that needs to be done for the last minute and then panic, which is when their adrenaline kicks in (a substance similar to amphetamine).
ADHD is one of the most rewarding ailments to treat. It leads to such improvement in so many aspects of one’s life. I am grateful for my profession and that it lends me the ability to help people who are not living life to their fullest potential.